[PDF]2016-2017 Porter Memorial Weekday Program...
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2016-2017 Porter Memorial Weekday Program Registration Weekday Program registration forms are available at the church office or at the program website:
www.portermemorialpreschool.com **Check a box to indicate in which program(s) you would like to enroll your child. 3-year-old Preschool (2 days) Time: 9:00 – 12:00 Age Requirement: Must turn 3 before October 1 and be completely potty trained Days: Mon/Wed OR Tu/Th (Circle preference)
Fees: Non-refundable registration fee Non-refundable material fee Monthly tuition (x9)
$100 $ 50 $150
Fees: Non-refundable registration fee Non-refundable material fee Monthly tuition (x9)
$100 $ 95 $195
Fees: Non-refundable registration fee Non-refundable material fee Monthly tuition (x9)
$100 $160 $260
4-year-old Preschool (3 days) Time: 9:00 – 12:00 Age Requirement: Must turn 4 before October 1 Days: Mon/Wed/Fri
4-year-old Preschool (5 days) Time: 9:00 – 12:00 Age Requirement: Must turn 4 before October 1 Days: Mon thru Fri
Lunch Bunch After-School Program Time: 12:00 – 2:00 Requirement: Enrolled preschooler
Fees: See attached details on Page 4
Days: Mon thru Fri
Registration Process: Registration fee is due upon enrollment. Material fee is due by June 1 to continue the enrollment process. (Material fee pays for t-shirt, sweatshirt, curriculum, and equipment.) First tuition payment is due August 1. A current immunization certificate is required before the first day of school.
Parent signature needed below: I understand that the monthly tuition is paid in nine equal monthly installments and shall be paid on the first of each month. The first tuition payment is due by August 1st. No reduction can be made for absences or in the event that school is cancelled due to inclement weather. If payment is not received by the 10th of the month, a $10 late fee will be applied. A thirty-day paid notice is required if you withdraw from the program. If for any reason you need to drop from the program before the fall session begins, you must notify Mandy Benton by August 1st in order to avoid paying August tuition.
PARENT’S SIGNATURE _____________________________________
DATE:_______________________________
For more information, please contact Mandy Benton at the church office 859-272-3441. Forms must be brought to the church office or mailed to: Porter Memorial Weekday Program, c/o Mandy Benton, 4300 Nicholasville Rd., Lexington, KY 40515.
PORTER MEMORIAL BAPTIST CHURCH WEEKDAY PRESCHOOL 4300 Nicholasville Road Lexington, KY 40515 (859) 272-3441 www.portermemorialpreschool.com PERSONAL INFORMATION The information that you give on this questionnaire will increase the teacher’s understanding of your child. It will enable the teacher to determine your child’s needs and interests much more quickly. Child’s Full Name_____________________________________________________ Gender_____________________ What name do you want used for your child in the classroom? ____________________________________________ Address: __________________________________________ Home Phone: _________________________________ City____________________________________State_______________________________Zip__________________ Age_____________ Birthday: Month_______________________ Day __________________Year _______________ Father’s Name ________________________________________________________ Birthdate: _________________ Father’s Address: ________________________________________________________________________________ Father’s E-mail Address: ______________________________________Father’s Cell Phone_____________________ Father’s Occupation: _____________________________________________________________________________ Employer’s Name__________________________________________ Business Phone_________________________ Christian? ________ Church Member? ________ Where? _______________________________________________ Church activities_________________________________________________________________________________ Mother’s Name ______________________________________________________ Birthdate __________________ Mother’s Address:_______________________________________________________________________________ Mother’s E-mail Address_____________________________________ Mother’s Cell Phone: ___________________ Mother’s Occupation_____________________________________________________________________________ Employer’s Name __________________________________________ Business Phone ________________________ Christian? ________ Church member? ________ Where? _______________________________________________ Church Activities ________________________________________________________________________________ Name and ages of brothers and sisters_______________________________________________________________ Are other relatives living in your household?__________________________________________________________ Is the child adopted? _________ If so, at what age?____________________________________________________ Name of preschool your child previously attended/Teacher______________________________________________ Church organizations which child attends: ____________________________________________________________ What fears does he/she have, if any_________________________________________________________________ State his/her reactions__________________________________________________________________________ 2 of 4 Pages
Explain any nervous habits such as thumb sucking, nail biting, etc. _________________________________________ _______________________________________________________________________________________________ Explain any special problems involving social relationships, diet, etc.________________________________________ _______________________________________________________________________________________________ Explain the usual type of discipline or guidance practiced in the home ______________________________________________ _______________________________________________________________________________________________ Is your child left-handed or right-handed? _______________________ Has he/she had any serious illnesses, operations or accidents?________
If so, describe and give age of child at the
time __________________________________________________________________________________________ Reasons for selecting this preschool _________________________________________________________________ Can we include your name, address, and telephone number for the class directory? YES___________ NO_________ Child’s Doctor ______________________ Doctor’s Phone # ______________ Preferred Hospital ________________ Allergies/Special Needs____________________________________________________________________________ Is your child under a doctor’s care for this? Yes ___________ No __________ Is a current Immunization Certificate attached? Yes________ No __________
In case of sickness or in the event my child is injured while attending preschool at Porter Memorial Baptist Church, my permission is granted for any staff member in charge to administer treatment or obtain necessary medical attention to stabilize my child. I also agree to use my family health insurance as the primary coverage. Parent’s Signature __________________________________________________ Date _______________________
PERMISSION TO PHOTO, VIDEO, AND /OR RECORD I,_________________________________________, parent/legal guardian of _______________________________, herby grant permission to the Porter Memorial Weekday Education Program to use my child’s photograph, and /or voice in any way that would reasonably portray programs of the Porter Memorial Weekday Program. This includes pictures taken in the classroom, on field trips, or at school programs. This also includes pictures (with no names) that we may post on Facebook as well as our web-site, www.portermemorialpreschool.com. I further release the staff from any damages in using my child’s photograph, and/or voice. _______________________________________________________ Signature of Parent of Guardian
3 of 4 Pages
___________________________________ Date
Lunch Bunch is from 12:00 PM – 2:00 PM and is opened to children who are enrolled in Porter Memorial Weekday Program. Children bring their lunch and have a great time extending their day with games and story time. *You may register your child for any day(s) he/she attends preschool. *Once you have registered for Lunch Bunch, it will be your responsibility to pay for the days you have registered for. Payment for missed days will not be refunded, and any changes must be made through the director. A twoweek paid notice is required to withdraw. *Payment is expected at the beginning of each month with preschool tuition. There will be nine months of lunch bunch tuition. (August and December will be half price) The cost is as follows: A non-refundable registration fee of $25 is due with application. 1 Day - $45.00 per month 4 Days - $155.00 per month 2 Days -$85.00 per month 5 Days - $ 190.00 per month 3 Days -$120.00 per month *I understand my child will be enrolled in Lunch Brunch based on availability of openings. If there are openings available in the program, I must submit $25 non-refundable registration fee and the registration form to hold a spot for my child. If no spots are available, my child may be placed on the waiting list at no cost.
My child is enrolled in preschool on the following days (please circle one): Monday/Wednesday/Friday
Monday/Wednesday
Tuesday/Thursday
Monday-Friday
Lunch Bunch will be offered five days per week. Please check the day/days you prefer your child to attend Lunch Bunch. Your child must attend the same day/days each week. I prefer: _____ Monday
_____ Tuesday
_____ Wednesday
_____ Thursday
_____ Friday
I would like to enroll my child in the Porter Memorial Lunch Bunch Program. ______________________________________ Child’s Name ______________________________________ Father’s Name
____________________________________ Mother’s Name
4 of 4 Pages
